Provider First Line Business Practice Location Address:
1 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
1ST FLOOR-PROFESSIONAL BLDG
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45005-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-420-5045
Provider Business Practice Location Address Fax Number:
513-420-5679
Provider Enumeration Date:
09/06/2006